Evidence Based Veterinary Medicine

Question 1

What are 5 other types of veterinary medicine?

Answer 1

• Anecdote-based
• Eminence-based
• Faith-based
• Internet-based
• Nervousness-based

Question 2

What is evidence based veterinary medicine?

Answer 2

EBVM – use of best available scientific evidence, in conjunction with clinical expertise and consideration of owner and patient factors, to make the best clinical decisions for patients.

Question 3

Why is EBVM important?

Answer 3

• Information overload
• Pharmaceutical reps are trying to sell you something
• Internet sources are unreliable
• Finding the best protocols to treat animals

Question 4

What can limit actions of EBVM in practice?

Answer 4

• Time – it can be challenging to find the time in a daily work schedule that includes consults, surgeries, emergencies, etc
• Access to journal articles and databases
• Client access to evidence - Clients have access to many of the same resources that veterinary professionals do, but usually lack the clinical expertise to assess whether the advice they find online is sensible. They may have attempted diagnosis, and treatment, before seeking veterinary advice, and the veterinary surgeon now has an important role in educating owners
• A dearth of evidence - Experts agree that there is a lack of high-quality published evidence for veterinary medicine (Dean and Brennan, 2016; Lanyon, 2014), especially in comparison with the larger evidence-base for human medicine and that funding is an issue

Question 5

What does the use of EBVM allow?

Answer 5

• Reduce errors
• Communication with clients
• Facilitate better clinical decision making
• Improve patient care

Question 6

What are the 5 steps of EBVM?

Answer 6

1. Ask – defining a clinical question that is of interest and hopefully answerable
2. Acquire – finding the best available evidence to answer the question
3. Appraise – assessing the quality of the relevant evidence found
4. Apply – implementing the evidence found
5. Assess – evaluating the impact of the implementation and changes in clinical practice

Question 7

What are some examples of EBVM at UoB?

Answer 7

Database searching
Research study design
Epidemiology
Statistical analyses

Question 8

What are the 3 elements that make up the practice of EBVM?

Answer 8

• Best evidence
• Clinical expertise
• Owner and animal circumstances

Question 9

What is the purpose the the Ask stage of EBVM?

Answer 9

In order to practice EBVM, we must be prepared to question what we do and change accordingly.
By questioning our practice in a critical way, we can move in a direction that keeps us up to date; also, by using the best possible evidence, we can offer our patients the best possible outcomes.
Well-formed questions underpin the very core of scientific methodology.

Question 10

What 5 main topic areas can clinical questions be sorted into?

Answer 10

1. Treatment - treatment choices made about patients in practice: drugs or medicines, surgical methods, changes in diet or management, etc. Best answered by randomised controlled trials when available.
2. Prognosis and incidence - the likelihood of disease or the progression of disease over time. Best answered by cohort studies.
3. Aetiology or risk - investigate the origin of disease or the factors influencing development of a certain condition or disease. Best answered by cohort, case-controlled or cross-sectional studies.
4. Diagnosis - identification of a disorder based on the animal’s presenting signs. Best answered by diagnostic test validation studies.
5. Prevalence - consider the frequency of disease at a certain point in time. Best answered by cross-sectional studies.

Question 11

What is the most commonly used system to format clinical questions?

Answer 11

PICO system:

• P – Patient: population and/or problem
• I – Intervention: treatment, or thing of Interest: prognostic factor or exposure
• C – Comparator: comparison or control
• O – Outcome